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Metformin (oral route)

Description and brand name

Drug Information Provider: Merative, Micromedex ®

American brand name

Fortamette
Phage
Glucophage XR
joke
Riomet
Riomet ER

canadian brand name

ACTMetformin
AG-metFORMIN - BlackBerry
AG-metFORMIN - Odorless
apolipometformin
apolipometformin
Oro metformin
AVA metformin
Biometformin
domitfomin

describe

Metformin is used to treat high blood sugar caused by a type of diabetes or sugar diabetes called type 2 diabetes. With this type of diabetes, the insulin produced by the pancreas is unable to carry sugar into the body's cells, preventing them from functioning properly. Metformin alone, along with an oral antidiabetic drug called a sulfonylurea or insulin, will help lower blood sugar that is too high and help restore the way food is used to produce energy.

Many people can control type 2 diabetes through diet and exercise. When you have diabetes, it is always important to follow a specially planned diet and exercise program, even if you are taking medications. To work properly, the amount of metformin you take must be balanced with the amount and type of food you eat and the amount of exercise you get. If you change your diet or exercise, you will need to test your blood sugar to determine if it is too low. If this happens, your doctor will teach you what to do.

Metformin does not help people with insulin-dependent or type 1 diabetes because their pancreas cannot produce insulin. Their blood sugar is best controlled with insulin injections.

This medicine can only be purchased with a doctor's prescription.

This product is available in the following dosage forms:

Tablet, extended release version
Suspension, extended release
pill
solution
tablet, extended release, 24 hours

before use

When deciding to use a medication, the risks and benefits of taking the medication must be weighed. This is a decision you and your doctor will make. For this drug, the following factors should be considered:

allergy

Tell your doctor if you have ever had any unusual or allergic reaction to this or any other medicine. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For over-the-counter products, read the label or package ingredients carefully.

Pediatrics

Appropriate studies performed to date have not demonstrated pediatric-specific issues that would limit the use of metformin oral solution, extended-release oral suspension, and tablets in children 10 to 16 years of age. However, the safety and effectiveness of metformin extended-release tablets in the pediatric population have not been established.

Geriatrics

Although appropriate studies on the relationship between age and the effects of metformin have not been conducted in the elderly population, problems specific to the elderly are not expected to limit the use of metformin in the elderly. However, older patients are more likely to develop age-related kidney problems, so caution may be needed in patients receiving metformin. This drug is not recommended for people 80 years and older who have kidney problems.

breast-feeding

There have not been adequate studies in women to determine the risk to the infant when this medication is used during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

drug interactions

Although some drugs should not be used together at all, in other cases two different drugs can be used together even though an interaction is possible. In these cases, your doctor may want to change the dosage, or may need to take other precautions. It is especially important that your health care professional knows if you are taking any of the following medicines while you are taking this medication. The following interactions have been selected based on their potential significance and are not necessarily all-inclusive.

It is not recommended to use this medicine with any of the following medicines. Your doctor may decide not to treat you with this medication or change some other medications you take.

acetic acid
Diatrizoate
Ethyl sulfide oil
Iodobenzoic acid
iodobitol
locaric acid
Acetoacetic acid
Iodamide
iopan
iodixanol
Iodized hippuric acid
iodopyridine
Iodoxamic acid
Glycyrrhizinate
glycine
iohexol
iomepropanol
iopamidol
Iopanoic acid
iodopentol
Iodophenyl ethyl ester
Isopropionic acid
Iosic acid
Iodomet
Iotas
chaotaramat
eotroland
Iodokoric acid
Iodoxamine
iodosamic acid
iodoboda
Metrazine
Chuanying acid
sodium tyrosine

Using this medication with any of the following medicines is usually not recommended, but may be needed in some cases. If two drugs are prescribed at the same time, your doctor may change the dose or how often you use one or both drugs.

Abiraterone acetate
Acetazolamide
Alogliptin
aspirin
Bepagliflozin
bictegravir
Brinzolamide
Bupropion
capmatinib
Chloroquine
chlorpropamide
Cimetidine
Ciprofloxacin
dashabwe
delafloxacin
dichlorphenamide
Dofetilide
dolutegravir
Dorzolamide
Enoxacin
fedratinib
fexinidazole
Gatifloxacin
Jimmyfloxacin
Glimepiride
Glipizide
Excellent hypoglycemic
gpafloxacin
Hydroxychloroquine
iopromide
ioversol
isavuconazole
Lanreotide
Levofloxacin
Levoketoconazole
Liraglutide
Lomefloxacin
Methazolamide
moxifloxacin
Naglina
Norfloxacin
Octreotide
Ofloxacin
ombitasvir
paretaprevir
pariseptide
pioglitazone
Ranolazine
repaglinide
Semaglutide
sitagliptin
somatrogongra
Soxgliflozin
Sparfloxacin
tafenoquin
lipoic acid
Tolasulfonamide
tolbutamide
topiramate
trovafloxacin
Vandetanib
Zonisamide

Using this medication with any of the following medicines may increase your risk of certain side effects, but taking both medicines together may be the best treatment for you. If two drugs are prescribed at the same time, your doctor may change the dose or how often you use one or both drugs.

acebutolol
atenolol
Betaxolol
bisoprolol
Momordica charantia
carteolol
carvedilol
Celilor
colavilan
Esmolol
Fenugreek
Glucomannan
Guar gum
isocarboxazid
labelore
Levobunolol
linezolid
Methylene blue
Metyrolol
Metoprolol
Nadolol
Nebivolol
Oxyprenolol
Ozanimod
Patty Romer
Spray Bolol
Phenelzine
Pindolol
Pralor
procarbazine
propranolol
Plantago
Resagiline
rifampicin
safinamide
Silaijilan
Sotalol
timolol
Tranylcypromine
Verapamil

Other interactions

Certain medications should not be used with or around eating or eating certain types of food because interactions may occur. Using alcohol or tobacco with certain medications may also cause interactions. The following interactions have been selected based on their potential significance and are not necessarily all-inclusive.

Proper use

This medication usually comes with a patient information insert. Before taking this medicine, read the information carefully and make sure you understand it. If you have any questions, please consult your doctor.

Carefully follow the special meal plan your doctor gives you. This is a very important part of managing the condition and is necessary if the medication is to work properly. Additionally, exercise regularly and test your blood or urine for sugar as directed.

Metformin should be taken with food to help reduce stomach or intestinal side effects that may occur during the first few weeks of treatment.

Swallow the tablet or extended-release tablet whole with a full glass of water. Do not crush, break or chew it.

When you take extended-release tablets, some of the tablets may pass into your stool after your body absorbs the medicine. This is normal and nothing to worry about.

Measure oral solutions with labeled measuring spoons, oral syringes, or medicine cups. A regular household teaspoon may not hold the right amount of liquid.

Measure mixed extended-release oral suspension using the dosage cup provided. If you do not have a dosing cup, ask your pharmacist for one.

Use only the brand of this medication prescribed by your doctor. Different brands may work differently.

You may notice improvements in blood sugar control within 1 to 2 weeks, but the full effects of blood sugar control may take up to 2 to 3 months. If you have any questions about this, please ask your doctor.

dose

The dosage of this drug will vary for different patients. Follow your doctor's instructions or the directions on the label. The information below contains only average doses of this drug. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine you take depends on the strength of the medicine. Additionally, the daily dose you take, the time allowed between doses, and the length of time you take the medication depend on the medical problem for which you are using the medication.

For type 2 diabetes:
- For oral dosage form (extended-release tablets):
  - Adult-
    - Metformin (Fortamet®) alone: First, take 1,000 milligrams (mg) once daily with dinner. If needed, your doctor may increase your dose until your blood sugar is under control. However, the dose usually does not exceed 2500 mg per day.
    - Metformin (Glucophage® XR) alone: First, take 500 mg once daily with dinner. If needed, your doctor may increase your dose until your blood sugar is under control. However, the dose usually does not exceed 2,000 mg per day.
    - Metformin (Glumetza®) alone: First, take 500 mg once daily with dinner. Then, if needed, your doctor may increase your dose until your blood sugar is under control. However, the dose usually does not exceed 2,000 mg per day.
    - Metformin vs. sulfonylureas: Your doctor will determine the dosage of each drug.
    - Metformin with insulin: Initially, 500 mg once daily. Then, if needed, your doctor may increase your dose by 500 mg each week until your blood sugar is under control. However, the dose usually does not exceed 2500 mg per day.
  - Children - Use and dosage must be determined by your doctor.
- For oral dosage forms (extended-release suspension):
  - Adults - Initially, take 5 milliliters (mL) once daily with the evening meal. If needed, your doctor may increase your dose by 5 mL each week until your blood sugar is under control. But the daily dose usually does not exceed 20 ml.
  - Children 10 to 16 years - Initially, take 5 ml once daily with dinner. If needed, your doctor may increase your dose by 5 mL each week until your blood sugar is under control. But the daily dose usually does not exceed 20 ml.
  - Children under 10 years of age - Use and dosage must be determined by your doctor.
- For oral dosage forms (solutions):
  - Adult-
    - To use metformin alone: First, take 5 milliliters (mL) twice a day or 8.5 mL once a day with a meal. If needed, your doctor may increase your dose until your blood sugar is under control. However, the dose usually does not exceed 25.5 ml per day.
    - Metformin vs. sulfonylureas: Your doctor will determine the dosage of each drug.
    - Metformin with insulin: Initially, 5 mL once daily. If needed, your doctor may increase your dose until your blood sugar is under control. But the daily dose usually does not exceed 25 ml.
  - Children 10 to 16 years - Initially, take 5 ml twice daily with food. If needed, your doctor may increase your dose until your blood sugar is under control. But the daily dose usually does not exceed 20 ml.
  - Children under 10 years of age - Use and dosage must be determined by your doctor.
- For oral dosage forms (lozenges):
  - Adult-
    - Taking metformin alone: First, take 500 milligrams (mg) twice a day with breakfast and dinner, or 850 mg a day with breakfast. If needed, your doctor may increase your dose until your blood sugar is under control. Your doctor may then ask you to take 500 or 850 mg two to three times a day with meals. However, the dose usually does not exceed 2550 mg per day.
    - Metformin vs. sulfonylureas: Your doctor will determine the dosage of each drug.
    - Metformin with insulin: 500 mg daily initially. If needed, your doctor may increase your dose by 500 mg each week until your blood sugar is under control. However, the dose usually does not exceed 2500 mg per day.
  - Children 10 to 16 years of age - Initially, take 500 mg twice daily after breakfast. If needed, your doctor may increase your dose until your blood sugar is under control. However, the dose usually does not exceed 2,000 mg per day.
  - Children under 10 years of age - Use and dosage must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and return to your regular dosing schedule. Do not double the dose.

storage

Store medication in an airtight container at room temperature, away from heat, moisture, and direct light. Avoid freezing.

Keep out of reach of children.

Do not keep expired medications or medications that are no longer needed.

Ask your health care professional what to do with any medicines you don't use.

Precaution

It is very important that your doctor check you or your child's progress at regular visits, especially during the first few weeks you take this medication. Blood and urine tests may be needed to check for adverse effects.

This drug may interact with the dyes used in X-rays or CT scans. Your doctor should advise you to stop taking it before having any medical tests or diagnostic tests that may cause you to produce less urine than usual. If your kidney function test results are normal, you may be advised to start taking your medicine again 48 hours after the test or test.

Make sure that any doctor or dentist who treats you knows that you are using this medication. You may need to stop using this medication several days before surgery or medical tests.

It is important to carefully follow any instructions from your healthcare team about:

Alcohol - Drinking alcohol may cause severe hypoglycemia. Discuss this with your health care team.
Other medicines - Do not take other medicines unless discussed with your doctor. This especially includes over-the-counter medicines such as aspirin, and medicines used to control appetite, asthma, colds, coughs, hay fever, or sinus problems.
Counseling - Other family members need to learn how to prevent side effects or assist if they occur. Additionally, patients with diabetes may need special counseling regarding changes in diabetes medication dosage that may occur due to lifestyle changes, such as exercise or dietary changes. Because people with diabetes can have problems during pregnancy, they may need counseling about birth control and pregnancy.
Travel – Carry recent prescriptions and medical history with you. Prepare for emergencies as you normally would. Account for time zone changes and keep meal times as close to your usual meal times as possible.
In an emergency - Sometimes you may need emergency assistance for problems caused by diabetes. You need to be prepared for these emergencies. It is best to wear a medical identification (ID) bracelet or necklace at all times. Also, carry an identification card in your purse or purse that states you have diabetes and lists all your medications.

In some cases, too much metformin can cause lactic acidosis. Symptoms of lactic acidosis are severe and appear quickly, often when other serious health problems unrelated to the drug are present, such as a heart attack or kidney failure. Symptoms of lactic acidosis include abdominal or stomach discomfort, loss of appetite, diarrhea, fast or shallow breathing, general malaise, severe muscle pain or cramps, unusual drowsiness, tiredness, or weakness.

If symptoms of lactic acidosis occur, seek emergency medical assistance immediately.

This medication may cause ovulation in some premenopausal women who have irregular periods. This can increase the chance of pregnancy. If you are a woman of childbearing potential, you should discuss birth control options with your doctor.

This medicine may cause hypoglycemia (low blood sugar). This condition is more common when this medication is taken with certain medications. Low blood sugar must be treated before it causes you to pass out (lose consciousness). People experience different symptoms of hypoglycemia. It's important to know what symptoms you typically have so you can treat them quickly. Talk to your doctor about the best ways to treat low blood sugar.

High blood sugar can occur if you don't take enough medicine or miss a dose, eat too much or don't follow your meal plan, have a fever or infection, or don't exercise as usual. High blood sugar can be serious and must be treated immediately. It's important to know what symptoms you have so you can get treatment quickly. Talk to your doctor about the best ways to treat high blood sugar.

High blood sugar can occur if you don't exercise as much as usual, have a fever or infection, don't take enough or skip a dose of diabetes medication, eat too much, or don't follow your eating plan.

side effect

In addition to their desired effects, medications may cause some adverse effects. Although not all of these side effects will occur, if they do occur, they may require medical attention.

Consult your doctor immediately if any of the following side effects occur:

relatively common; generally

Abdominal or stomach discomfort
Cough or hoarse voice
decreased appetite
diarrhea
Breathing quickly or shallowly
fever or chills
general feeling of discomfort
lower back or side pain
muscle pain or cramps
Pain or difficulty urinating
sleepy

Unusual

anxiety
blurry vision
Chest discomfort
break out in cold sweat
coma
Confused
Cool, pale skin
frustrated
Difficulty or labored breathing
Dizziness
A fast, irregular, pounding, or rapid heartbeat or pulse
warm feeling
Headache
increased hunger
increased sweating
nausea
nervous
nightmare
Redness of the face, neck, arms, and occasionally the upper chest
epileptic seizure
tremble
unclear speech
Chest tightness
unusual tiredness or weakness

rare

Behavioral changes similar to drunkenness
difficulty concentrating
drowsiness
lack or loss of strength
disturbed sleep
unusual drowsiness

Some side effects may occur that usually do not require medical attention. These side effects may go away during treatment as your body adjusts to the medication. Additionally, your health care professional may be able to tell you ways to prevent or reduce some of these side effects. If any of the following side effects persist or are bothersome, or if you have any questions about them, talk to your health care professional: